BVFP Patients Achieve Bilateral Fold Movements with Selective Laryngeal Reinnervation

by Amy E. Hamaker •

What is the extent of airway improvement and voice quality in patients with bilateral vocal fold paralysis (BVFP) who underwent selective laryngeal reinnervation surgery?

Bottom Line: The selective laryngeal reinnervation procedure can achieve physiological movements of the bilateral vocal folds in selected patients with BVFP.

Background: BVFP, which is usually caused by injury to the bilateral recurrent laryngeal nerves (RLNs), is the most severe complication of thyroid surgeries. Traditional BVFP treatment mainly aims to enlarge airway at the glottis level, but this is often achieved at the expense of worsening voice and deglutition function. Selective laryngeal reinnervation aims to restore physiological movements of the vocal folds, but laryngeal synkinesis remains an unsolved problem.

Study design: Surgical study of seven patients with BVFP caused by thyroid surgeries. Patients underwent selective laryngeal reinnervation surgery between January 2012 and March 2015.

Setting: Department of Otolaryngology–Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, People’s Republic of China.

Synopsis: All patients were females, from 30 to 56 years and all had thyroidectomies, with a denervation course from one to 13 months. Study authors sought to achieve functional larynx rehabilitation using the phrenic nerve upper root and the hypoglossal nerve thyrohyoid branch to simultaneously reinnervate the abductor and adductor muscles. At four to seven months after the reinnervation surgery, stroboscopic video recordings revealed that bilateral vocal folds began to show moderate to maximal abduction during inspiration, with slight posterior chink or complete glottal closure during phonation. Unilateral or bilateral vocal folds in six patients achieved moderate to maximal abductive excursion. In recorded voice samples, the G value was 0.4 at 12 months postoperatively, significantly lower than the preoperative G value of 0.8. Postoperative jitter, shimmer, and NHR were also significantly lower than the preoperative values. Maximal inspiratory pressure was still lower than the normal reference value at 12 months postoperatively but higher than the preoperative and three-month postoperative values. Preoperative EMG showed that abnormal spontaneous activity, such as positive waves, fibrillations, and complex repetitive discharges, was recorded in the PCA and TA muscles on the right and left sides. At 12 months postoperatively, in five cases during phonation, full interference was recorded in the TA muscles, and full interference was recorded in the PCA muscles during inspiration. Limitations included the small study size.

Citation: Li M, Zheng H, Chen S, Chen D, Zhu M. Selective reinnervation using phrenic nerve and hypoglossal nerve for bilateral vocal fold paralysis. Laryngoscope. 129:2669–2673.